basketdiva
Pearl Clutcher
Posts: 3,615 
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Post by basketdiva on Jul 25, 2016 16:14:37 GMT
Read scrappinghappy's post about her surgery and saw he she will have O/T 2x week for 4-6 months. It got me thinking about our insurance ( which is good) and the number of visits it pays for-20 per year. Any more visits would be paid out of pocket.
So just curious how many visits does your insurance allow/pay for in a calendat year?
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Post by secondlife on Jul 25, 2016 16:36:06 GMT
I get 26 self referred OT or PT a year and unlimited by doctor's order.
My chiropractor is a physical therapist so I can use my benefit with him and that's excellent.
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Post by pierkiss on Jul 25, 2016 16:39:49 GMT
30 per year for our entire family for both OT and PT combined for our entire family to share.
My son will blow through those by the end of this year. We are lookin at new plans this fall. I am super pissed about this.
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Post by auntkelly on Jul 25, 2016 16:40:39 GMT
We have unlimited, thank goodness. My daughter has a serious knee issue and has had over two hundred PT sessions over the last two years.
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Post by Basket1lady on Jul 25, 2016 16:41:27 GMT
We have Tricare. We have unlimited visits.
I had a sphenoid sinus infection that ate into my right middle year and caused horrible vertigo. The CT was read incorrectly and it went uncaught for several months. It took 18 months of OT and PT before I was anything near normal. I'm 2 years out from being done with PT and I'm actually in the ENT's office for a check up.
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Post by justkat on Jul 25, 2016 16:41:51 GMT
Any type of PT/OT has to be ordered by a doctor. Once he writes the order I'm covered for unlimited visits.
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basketdiva
Pearl Clutcher
Posts: 3,615
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Post by basketdiva on Jul 25, 2016 16:53:12 GMT
Any type of PT/OT has to be ordered by a doctor. Once he writes the order I'm covered for unlimited visits. Even if it's ordered by the doctor, our policy still has a limit. All the policies we've ever had ( including the extremely generous one we had at my husband's previous job) have had a limit. I'm surprised by the policies that offer unlimited visits and glad for those who get that benefit. |
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Post by justkat on Jul 25, 2016 16:56:04 GMT
Any type of PT/OT has to be ordered by a doctor. Once he writes the order I'm covered for unlimited visits. Even if it's ordered by the doctor, our policy still has a limit. All the policies we've ever had ( including the extremely generous one we had at my husband's previous job) have had a limit. I'm surprised by the policies that offer unlimited visits and glad for those who get that benefit. I should've said "per my policy, any type of PT/OT.... I'm thankful our policy is set up this way. I have severe chemo neuropathy and have needed quite a lot of PT and OT. There's no way I would've paid out-of-pocket for that. I wish everyone who needed this had access. |
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Deleted
Posts: 0
May 2, 2024 7:05:00 GMT
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Post by Deleted on Jul 25, 2016 16:58:51 GMT
The way mine works (Aetna...your plan may differ), is 25. At 25, they want justification to pay for any more visits. The thinking is that at 25 the issue should be resolved or something else done.
ETA: My benefit blurb says "unlimited" but in reality it works as stated above. Also, it must be doctor ordered.
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Post by Linda on Jul 25, 2016 17:32:43 GMT
we have a high-deductible plan so pretty much as many PT or OT visits as I want to pay for out of pocket (and are prescribed)...it would take quite a few indeed to reach my deductible. After that, I'm not sure...we've never met our deductible so I'm not really clear on what is/isn't covered at that point
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gsquaredmom
Pearl Clutcher
Posts: 4,078
Jun 26, 2014 17:43:22 GMT
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Post by gsquaredmom on Jul 25, 2016 17:58:35 GMT
My hmo allows 60
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Post by Laurie on Jul 25, 2016 18:58:40 GMT
We are currently in the middle of this with my dd right now. Our policy allows 20 visits. However, I believe we can/will be approved for more if deemed medically necessary.
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Post by giatocj on Jul 25, 2016 19:04:28 GMT
As long as our deductible is met we can go in increments of 8 weeks. We just need the OT or PT to notify the insurance company each time there is an extension. I was very lucky because I needed many weeks of OT 2 years ago when I shattered my wrist.
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Post by snappinsami on Jul 25, 2016 21:12:04 GMT
I'm going through this now. Our insurance allows for 20. I think after that they will approve more if the physical therapist reports it to them as necessary. I'm on #12 today, and I'm hoping it's my last one. My shouldn't isn't totally better, but I'm at the point where it doesn't seem to be improving, so I'm not sure it's worth the copays to continue going.
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Post by mom on Jul 25, 2016 21:18:08 GMT
We have unlimited as long as they are in network. Not certain on out of network.
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